18. HIV/AIDS Prevention and Treatment

Abstract

Despite the alarming speed with which HIV/AIDS continues to spread around the world, several countries have achieved significant successes in curbing its transmission, including interventions that promote condom use, target populations that transmit the virus in both high– and low–risk groups, and focus on surveillance and control of sexually transmitted infections. However, the lack of sound evidence regarding the effectiveness of HIV interventions hinders policy makers' ability to tailor those interventions to the nature and stage of national epidemics.

Yet, evidence is mounting in support of certain interventions, including school–based sex education, peer education for sex workers, avoidance of unwanted pregnancies among infected mothers, use of antiretroviral therapy by infected mothers, needle–exchange programs for illegal drug users, and implementation of such blood safety practices as screening all donated blood. Countries with low–level epidemics should emphasize interventions that target individuals at especially high risk of being infected or transmitting the virus, whereas countries experiencing generalized epidemics should target entire populations.

While a number of promising new prevention interventions are in the pipeline, the assessment of most of these strategies is years away. In contrast, research on care and treatment has proven far more successful. For example, the ability of HIV to evolve resistance to antiretroviral drugs rapidly appears to assure continued investment in new drug development. The greatest challenge facing developing countries is to adapt care and treatment modalities in ways that help prolong high–quality life without overburdening a fragile health care infrastructure that must also address other pressing health concerns.